Healthcare Provider Details

I. General information

NPI: 1043477441
Provider Name (Legal Business Name): THERESA ONG LIU DUMLAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA LIU DUMLAO MD

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 08/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 E BANNER GATEWAY DR SUITE 450
GILBERT AZ
85234-2165
US

IV. Provider business mailing address

2940 E. BANNER GATEWAY DR SUITE 450
GILBERT AZ
85234-2165
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax: 480-256-3359
Mailing address:
  • Phone: 480-256-6444
  • Fax: 480-256-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberP0083
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number25912
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number25912
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number32590
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: